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Three surgeries and more than a year of physical therapy later, Paige Gilliland pedals a
stationary bike at the Ohio Orthopedic Center of Excellence on the Northwest Side.

In her most-recent bout of physical therapy, she does squats and leg lifts to strengthen her
front and back leg muscles after having had reconstructive surgery on her torn ACL, the anterior
cruciate ligament that helps stabilize the knee joint.

“I know the drill now,” said Gilliland, a soccer player who attends St. Francis DeSales High
School and is two months into her third round of physical therapy. “It’s frustrating because I’ve
been in the same spot for the past three years. ... I haven’t played a full season of high school,
and my first and last season will be my senior year.”

ACL injuries in athletes younger than 18 years old have increased over the past two
decades, and female soccer players between the ages of 15 and 20 are most at risk, according to a
report published recently by the American Academy of Pediatrics.

The report outlines new guidelines to diagnose, treat and prevent ACL injuries as more young
athletes are participating in high-demand sports.

“Girls have to work harder to strengthen their hamstring and muscle equality,” said Dr.
Cynthia LaBella, the medical director of the Institute for Sports Medicine at Children’s Hospital
of Chicago, who helped write the new guidelines. “Girls tend to rely on their ligaments and bones
to stop joint motion rather than use all muscle groups around that joint to stabilize it.”

Gabby Miller, a senior at Pickerington Central High School, can now cut fluidly between
defenders on the soccer field thanks to the combination of strength training, stretching and
jumping exercises the report recommends.

Miller was out for both her freshman and junior seasons because she tore her ACL in both
knees. The report says the exercises can reduce a young female athlete’s risk of injury by 72
percent.

“There is a big push now in sports medicine for prevention programs,” said Dr. Steven Cuff, a
pediatric sports-medicine physician at Nationwide Children’s Hospital. “We work with teams on
things such as strengthening, balance, flexibility and biomechanics to teach kids how to lean and
jump in a way that will decrease their risk of ACL injuries.”

LaBella said ACL injury rates increase during puberty as body weight, height and bone length
increase. For boys, testosterone levels go up, which helps create new muscle mass. Girls have to be
trained to maintain muscle strength because it doesn’t grow at the same rate as their bodies, she
said.

ACL tears happen when a majority of body weight is behind the knee when an athlete quickly
changes direction or when the knee is overextended. Most people hear a pop at the time of injury
and feel pain on the outside and back of the knee when they put weight on it.

Dr. Matthew Beran, a pediatric orthopedic surgeon at Nationwide Children’s Hospital, said the
average time to recover from an ACL injury after reconstructive surgery is six months. At the
two-month mark during rehabilitation, athletes have to pass a jogging test to gain freedom to do
sports-specific exercises.

“This is not a career-ending injury,” Beran said. “It could be a season-ending injury, but
what’s great about this population (teenage athletes) is that they want to be out doing their
sport, and they are motivated and have the will to return.”

Athletes with ACL injuries are 10 times more likely to develop degenerative arthritis in the
knee when they are older, the report says. A family history of knee problems increases the
likelihood.

The Academy of Pediatrics recommends that doctors teach athletes and their parents about the
knee-conditioning exercises.

“We don’t want the message to be, ‘Don’t play sports,’” Cuff said. “We want them to do it and
do it safely.”

For more health coverage, look for Your Health on Sunday in The Dispatch and go to
dispatch.com/health.